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shoulder impingement assessment treatment examination physical therapy

Shoulder Impingement – 3 Keys to Assessment and Treatment

Shoulder impingement is a really broad term that is used too often. It has become such a commonly used junk term, such as “patellofemoral pain.”

Unfortunately, the use of such a broad term as a diagnosis is not helpful to determine the treatment process. There is no magical “shoulder impingement protocol” that you can pull out of your notebook and apply to a specific person.

I wish it were that simple.

To make the treatment process for shoulder impingement a little more simple, there are 3 things that I typically consider to classify and differentiate shoulder impingement.

Does Subacromial Decompression Surgery Really Do Anything?

Subacromial decompression surgery is a very common procedure performed for people with shoulder pain. The procedure is often recommended for people with “impingement syndrome” and was originally theorized to open up the subacromial space and help reduce biomechanical impingement. But recent research has challenged the effectiveness of the procedure, and even the diagnosis of “subacromial impingement” itself.

Special Tests for Rotator Cuff Tears

Rotator cuff tears are one of the most common injuries we see in orthopedic physical therapy. During the clinical examination of the shoulder, we want to perform special tests designed to detect a rotator cuff tear. In this article, I’ll share my 4 favorite special tests for rotator cuff tears that I perform during my clinical examination of the shoulder. These 4 tests do a good job detecting larger tears that are causing dysfunction.

Should We Delay Range of Motion After a Rotator Cuff Repair Surgery?

Based on a recent systematic review, I would continue to recommend performing control range of motion following rotator cuff repair surgery as it appears to be safe and effective at restoring motion and function sooner than if we delay rehabilitation.

6 keys to shoulder instability

6 Keys to Shoulder Instability Rehabilitation

Shoulder instability is a common pathology encountered in the orthopedic and sports medicine setting.

But “shoulder instability” itself isn’t that simple to understand.

Would you treat a high school baseball player that feels like their shoulder is loose when throwing the same as a 35 year old that fell on ice onto an outstretched arm and dislocated their shoulder? They’re both “shoulder instability,” right?

There exists a wide range of symptomatic shoulder instabilities from subtle recurrent subluxations to traumatic dislocations. Nonoperative rehabilitation is commonly utilized for shoulder instability to regain previous functional activities through specific strengthening exercises, dynamic stabilization drills, neuromuscular training, proprioception drills, scapular muscle strengthening program and a gradual return to their desired activities.

I’ve had great success rehabilitating dislocated shoulders and helping people return back to full activities without surgery. But to truly understand shoulder instability, there are several key factors that you must consider.

rehabilitation protocol following arthroscopic rotator cuff repair

Rehabilitation Protocol Following Arthroscopic Rotator Cuff Repair

There continues to be great debate over the most appropriate rehabilitation progression following rotator cuff repair. Although our surgical techniques have gradually progressed from full open repairs, to smaller mini-open repairs, to the current standard all-arthroscopic repairs, many clinicians continue to utilize the same rehabilitation guidelines from past invasive procedures. And more confusing is the lack of consensus among surgeons regarding the optimal postoperative rehabilitation protocol following arthroscopic rotator cuff repair. Protocols can vary as drastically as beginning gentle passive range of motion and isometric exercises post-operative week 1 to delaying 12 weeks for the initiation of similar exercises. I want to share the postoperative protocol that I have developed with Kevin Wilk and James Andrews to give you some guidance on how we are progressing patients.

shoulder impingement assessment and treatment

Shoulder Impingement – 3 Keys to Assessment and Treatment

Shoulder impingement really is a pretty broad term that most of us likely take for granted. It has become such a junk term, such as “patellofemoral pain,” especially with physicians. It seems as if any pain originated from around the shoulder could be labeled as “shoulder impingement” for some reason, as if that diagnosis is helpful to determine the treatment process.

Unfortunately, There is no magical “shoulder impingement protocol” that you can pull out of your notebook and apply to a specific person.

I wish it were the simple.

A thorough examination is still needed. Each person will likely present differently, which will require a variations on how you approach their rehabilitation.

But the real challenge when working with someone with shoulder impingement isn’t figuring out they have shoulder pain, that’s fairly obviously. It’s figuring out why they have shoulder pain.

Assessing the Shoulder Shrug Sign

The latest Inner Circle webinar recording on Assessing the Shoulder Shrug Sign is now available.